Provider First Line Business Practice Location Address:
100 E. 33RD STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-367-6030
Provider Business Practice Location Address Fax Number:
208-367-6123
Provider Enumeration Date:
07/09/2006